Table 1.

Comparison of Current Clinical Practices and Transformed Care Pathway for Management of Low Back Pain Care

Current Clinical PracticesTransformed Care Pathway
Before Care Seeking
  • Limited information on evidence-based back pain prevention
  • Pervasive biomedical perspective of pain in the public
Before Care Seeking
  • Biopsychosocial public education efforts to understand pain
  • Importance of physical activity for back pain prevention and self-management emphasized by health systems
  • Incentives for engaging in preventative behaviors and activities
Care Seeking
  • Multiple, inconsistent potential health system entry points
  • Medical diagnosis and imaging emphasized
  • Inconsistent decision-making on need for additional care
Care Seeking
  • Urgent or immediate care when indicated by medical necessity
  • Health system entry points consistently provide foundational care
  • Self-management strategies emphasized
  • Risk stratification and informed patient preferences guide decisions for additional care
Care Delivery
  • Pharmacological interventions emphasized
  • Care escalation based on provider preferences, local patterns and custom
  • Limited planning for exit from health system
  • Lack of preparation for self-management of recurrent episodes
  • High rates of invasive procedures without appropriate indications
  • Limited planning for exit from health system
Care Delivery
  • Non-pharmacologic, physical and behavioral interventions emphasized
  • Consideration of alternative non-pharmacologic modalities prior to escalation
  • Links between health system and population based resources to facilitate self-management
  • Care escalation based on risk/benefit assessment and shared decision-making
  • Individuals receiving invasive care meet appropriateness indications